CPT 96116: Neurobehavioral Status Exam, Face-to-Face Assessment
Medicare pays $97 and commercial payers pay $313 on average nationally for this procedure.
CPT code 96116 describes a face-to-face neurobehavioral status examination performed by a physician or other qualified healthcare professional that assesses a patient’s thinking, reasoning, and judgment; it is reported for the first hour of the clinical assessment including time spent interpreting findings and preparing a report. Service type: neurobehavioral status exam / clinical cognitive assessment. Typical site of service: outpatient clinic or office visit where a clinician conducts direct, face-to-face cognitive evaluation and documents interpretation and report preparation.
For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.
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National Reimbursement Benchmarks
Medicare’s mean rate for CPT 96116 is $97, which sits well below BUCA’s average commercial mean of $312.90, indicating a substantial gap between public and large commercial-average reimbursement for this code. This gap highlights that providers seeing a mix of payers will encounter markedly different mean reimbursements, with BUCA paying roughly $215.90 more on average than Medicare for the same service.
Dispersion (P75 minus P25) varies across commercial payers: Blue Cross Blue Shield shows the widest IQR at $175.50 (P75 $556.30 minus P25 $380.80), while Aetna is relatively tight with an IQR of $38.90 (P75 $112.30 minus P25 $79.40). UnitedHealth Group and Cigna have moderate dispersion at $85.00 and $69.00 respectively, and BUCA’s IQR is $121.20 (P75 $382.30 minus P25 $256.10). These differences reflect substantial variation in mid-range commercial reimbursement concentration.